Ovarian and uterine pathology

Question 1

Endometriosis

Answer 1

• Normal endometrial lining growing outside of the cavity
• Cause unknown
• painful sex, dysuria, 25% asymptomatic
• COCP (combined oral contraceptive pill), GnRH agonist/antagonist, progesterone antagonist
• Surgical – ablation/total abdominal hysterectomy with bilateral salpino-oophorectomy (TAH-BSO)
• Most common age = 30-40

Question 2

Inflammation of the endometrium

Answer 2

• Cause - pelvic inflammatory disease, IUCD, infection
• Histology - high lymphocytes and plasma cells
• Treated with analgesia, AB, remove cause

Question 3

Endometrial Polyps

Answer 3

• Sessile or polypoid oestradiol dependant uterine overgrowths
• <10% women in 40-50s
• Symptoms = intermenstrual/menopausal bleeding, menorrhagia, dysmenorrhoea
• Treatment - Medical = Progesterone/GnRH antagonists, Surgical = curettage

Question 4

Leiomyoma (Uterine fibroids)

Answer 4

• Benign tumours of myometrium
• ~20% of women in 30-50s
• Risk factors = nulliparity, obesity, genetics
• Symptoms = Menometrorrhagia
  Treatment - Medical = Coil, COCP, NSAID’s, Surgical = TAH, ablation

Question 5

Menometrorrhagia

Answer 5

iron deficiency anaemia

Question 6

Endometrial hyperplasia

Answer 6

• Due to increased oestradiol and decreased progesterone
• Risk factors = obesity, HNPCC/lynch syndrome
• Types = simple + complex
• Complex can be typical or atypical

Question 7

Malignant progression of hyperplasia

Answer 7

• Starts with simples endometrial hyperplasia, becomes complex, then atypical, then an invasive endometroid carcinoma
• Caused by excess oestrogens that cause endometrial growth
• Oestrogen changes driven by obesity

Question 8

Endometrial Adenocarcinoma

Answer 8

• Most common cancer of the female genital tract
• History = post-menstrual/inter-menstrual bleeding, pain if late
• Staging = FIGO
• Treatment = medical = POP, Surgical = TAH-BSO, adjuvant, chemo/radiotherapy

Question 9

Polycystic Ovary Syndrome definition

Answer 9

• Endocrine disorder causing hyperandrogenism and menstrual abnormalities leading to polycystic ovaries. Associated with infertility and endometrial hyperplasia/adenocarcinoma

Question 10

Polycystic Ovary Syndrome features

Answer 10

• 6-10% with disorder (20-30% with polycystic ovaries)
• Diagnosis made with fasting biochem screen
• Rotterdam criteria - 2/3 of cases = hyperandrogenism, irregular periods and polycystic ovaries
• Treatment - Medical = metformin, OCP, Surgical = ovarian drilling

Question 11

Endometritis

Answer 11

• Endometritis is inflammation of the inner lining of the uterus (endometrium) (IN SITU)
• Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge.
• It is the most common cause of infection after childbirth

Question 12

Polycystic Ovary Syndrome biochem screen results

Answer 12

low FSH, high LH, high testosterone

Question 13

3 correct components for breast screening triple assessment

Answer 13

• Clinical examination
• Mammogram/USS
• Core biopsy or FNA